A Day in the Life: Influences on Teen Pregnancy at Home and Abroad

Note: In May 2015, the Adolescent Pregnancy Prevention Campaign of North Carolina (APPCNC) became SHIFT NC (Sexual Health Initiatives For Teens).

Fact: Teens in Europe and in the United States generally have the same rates of sexual activity, but the United States has a teenage pregnancy rate three times that of Germany and France and four times of that the Netherlands. For the United States (which has the highest rate of teenage pregnancy in the developed world) to have the same rate of teen births as Germany, there would need to be roughly 340,000 fewer births by teenage mothers a year. How and why can such a discrepancy exist? To examine this question, let’s take a look a day in the (fictional) life of “Shelby,” a sixteen year old living in North Carolina, and “Laura,” a sixteen year old living in Germany. As we will see, the varying influence of education, media, peers, parents, and the availability of contraception combine to create a very different story when it comes to teen pregnancy at home and across the pond.

Shelby

Shelby hears the honk of car horn in the driveway. Peeking outside the window, she sees her boyfriend waiting to drive her to school. She shouts a quick goodbye to her parents and hops into the front seat beside him. Shelby and Tom have been dating for about two months and had sex for the first time last week. Shelby was tired of being the only one of her friends who had not had sex and felt that she could trust Tom. (Fact: Teens with sexually active friends are more likely to be sexually active themselves).

Shelby’s parents have no idea that she and Tom are sleeping together. The most they have ever discussed sex occurred one night two years ago, and was essentially included her father telling her, “If you ever get pregnant before the age of 25 you will grounded until you’re fifty,” after reading an article on Bristol Palin’s pregnancy. Birth control or safe sex practices were never discussed and Shelby figured her parents would just get mad at her for asking. (Fact: Only 10% of families in the U.S. engage in on-going conversations about sex with their teens. In a national sample of parents asked how often they talked with their children about sex, 54% reported never, 28% said rarely, and 5% said about once a year.) However, Shelby and Tom did practice safe sex. Tom used condoms that he purchased at a drugstore two towns over, one of the few places he felt comfortable buying them. (Fact: North Carolina schools are prohibited by law to distribute contraception to students.Teens that do not use contraception have a 90% chance of becoming pregnant within a year.) Shelby considered going on the Pill, but in the end decided it was more trouble than what it was worth; plus, she would be so embarrased if her mother found out. (Fact: If Shelby went to a family planning clinic to receive birth control, her insurance would pay for part of the contraception and her visit would be kept confidential. However, the birth control would still show up on the explanation of her benefits.)

As Shelby sits through her morning classes, she thinks about how relieved she is to no longer have to sit through “sex ed,” a misnomer that she and her friends found to be very uncomfortable. When Shelby had to take such classes, the focus was on abstinence only education and such was described as the only full proof way of preventing pregnancy. Now at least she knows her younger sister will get more helpful information on contraception and protection as a result of the Healthy Youth Act, which requires that all North Carolina schools teach on all FDA-approved methods of contraception. Still, Shelby thinks, shaking her head, it’s amazing how much you can forget after a year or two. (Fact:Sex education is required in grades 7-9—usually as part of health class– in North Carolina. There is not a set sex ed curriculum for counties in North Carolina to follow, nor are there set regulations for the United States as a whole.)

Later that day Shelby flips through an old gossip magazine. She smirks to see Bristol Palin featured in a Candie’s Foundation ad, part of the organization’s campaign to prevent teen pregnancy. She sighs as she realizes that Bristol and the girls in Teen Mom are her pregnancy “role models.” (Fact: The United States has few long term national prevention campaigns that are widely or consistently distributed. If anything, the United States has a “You play, you pay” mentality—which is one state’s current slogan.) Shelby is just happy that she can trust Tom to use condoms and believes that is enough to keep both of them safe.

Laura

Per tradition, Laura and her mother sit at the breakfast table, enjoying a morning meal of toast with nutella before the craziness of the upcoming day unfolds. Laura just told her mom about an older student at her school who just found out she was pregnant with twins, even though she claimed to be on the Pill.

Her mother sighs, “Did she not realize that she had to take it every day at the same time in order for it to be most effective? What about her partner—was he wearing condoms?” (Fact: German youth are five times more likely to be on the Pill than youth in the United States.)

Laura rolls her eyes, “I don’t knowww, Mom—I am not her. Maybe he was? I don’t know. It’s not like they’re difficult to get.” (Fact: 83% of male teens in Germany use condoms, which are readily available in a variety of public places, including restaurants and vending machines.)

Laura’s mom responds, “Well, you know how important it is to use a backup method. And if you have trouble getting any kind of method at all, you tell me and I will help you find one.”(Fact: In Germany, 73% of daughters and 53% of sons report receiving sexuality education from their parents. Parents in Germany support their teen’s use of protection in sexual relationships.)

“Trust me Mom, I know. This is the tenth time you have told me this month,” Laura says as she runs out the door. Though her tone is sarcastic, Laura is grateful for the open conversation she can have with her mother about these topics.

Funny enough, how to have a conversation about choosing the right birth control method with one’s partner was discussed in her morning class. Mom would be thrilled, Laura thought to herself, as she acted the part of a girl explaining how an IUD works to her boyfriend. (Fact: Schools in Germany have consistent sex education programs that are essentially integrated into all school subjects. Relationships are a key concern in the sex ed program, with a focus on dual support for sexual behavior.) Laura herself has not had sex yet, though not out of a sense of fear or a lack of information. Rather, she hasn’t had a serious boyfriend and finds herself busy enough hanging out with friends and playing field hockey. A few of her friends have had sex—in fact, Laura went with one of her girlfriends when she made the decision to go on the Pill. (Fact: Doctor visits and contraception are covered in Germany through their universal health care system.)

After a long day, Laura and a few friends begin the walk back home. On their way, they notice a new billboard stressing the importance of condom use in sexual relationships. They grin at the hokey tag line, though it’s no worse than the previous ads in its spot. Later, as they flip on the television, Laura sees a commercial that is reminiscent of what she had studied in health class, another part of the country’s nationwide campaign for safe sexual practices. (Fact: This nationwide campaign in Germany includes 4-6 TV spots on channels that have donated spots of free air time, billboards, and posters that publish new educational themes every 3 months, and advertisement partners who provide free printing and distribution to 70,000 locations.) The push for safe sex, all while stressing individual freedom and responsibility, is not lost on Laura. More than once today she was reminded how it important it is for her to be her own advocate.

What lessons do you think we can take from Europe in how we discuss and look at teen pregnancy and sexuality? Do you believe these lessons would be easily adopted in the United States?

If you want more information on the differences between teen sexual behavior in the United States and in Europe, check out the Advocates for Youth web site; they conducted an extremely interesting and informative report on the topic.